1-12 Osteoporosis in Childern - Dr. Hesham a Ghany

8/14/2019 1-12 Osteoporosis in Childern - Dr. Hesham a Ghany

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.E F.E F

a sy ste m ic ske le ta l d iso rd e rch a ra cte rise d b y lo w b o n e m a ss a n d-m icro a rch ite ctu ra l d e te rio ra tio n o f

,b o n e tissu e w ith a co n se q u e n t

in cre a se in b o n e fra g ility a n dsu sce p tib ility to fra ctu re


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ste o p e n ia in ch ild re nste o p e n ia in ch ild re n ( )M in e ra liza tio n d e fe ct ra ch itic O ste o p o ro sis O thers


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n cre a sin g d ia g n o sisn cre a sin g d ia g n o sis im p ro v e d ca re p ro v id e d to ch ild re n

w ith ch ro n ic illn e ss T h e a v a ila b ility o f m e th o d s to a sse ss

b o n e d e n sity in ch ild re n p o ssib ility o f m e d ica l tre a tm e n t h a s

a lso re su lte d in a n in cre a se d

a w a re n e ss o f o ste o p o ro sis


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EtiologyEtiology

Primary intrinsic boneabnormality

Osteogenesis

imperfecta (OI)

Idiopathic juvenileosteoporosis ( IJO)

Osteoporosispseudogliomasyndrome

Secondary Reduced mobility

Inflamatory cytokines

Systemic glucosteroids

Disordered puberty

Poor nutrition/lowbody weight


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v EDUCED MOBILITYEDUCED MOBILITY C e re b ra l p a lsy S p in a l co rd in ju ry a n d sp in a b ifid a

D u ch e n n e m u scu la r d ystro p h y

S p in a l m u scle a tro p h y H e a d in ju ry

U n kn o w n n e u ro d isa b ility


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v n fla m m a to ry cy to k in e sn fla m m a to ry cy to k in e s Ju v e n ile id io p a th ic a rth ritis

S y ste m ic lu p u s e ry th e m a to sis

D e rm a to m y o sitis In fla m m a to ry b o w e l d ise a se


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v yste m icyste m icg lu co co rtico id slu co co rtico id s R h e u m a to lo g ica l co n d itio n s In fla m m a to ry b o w e l d ise a se

N e p h ro tic syn d ro m e

D u ch e n n e m u scu la r d ystro p h y C y stic fib ro sis

Le u ka e m ia O rg a n a n d b on e m a rrow

tra n sp la n ta tio n


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v iso rd e re d p u b e rtyiso rd e re d p u b e rty T h a la ssa e m ia m a jo r A n o re x ia n e rv o sa

G o n a d a l d a m a g e d u e to

/ra d io th e ra p y ch e m o th e ra p y K lin e fe lte r sy n d ro m e

G a la cto sa e m ia


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v /oor nutrition low body/oor nutrition low bodyweighteight Anorexia nervosa Chronic systemic disease

Inflammatory bowel disease Cystic fibrosis Malignancy


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Mostly secondary Endocrine Connective tissue

GIT , ,Drugs steroids anticoagulants Immobilization

( )Primary rare


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steogenesis Imperfectasteogenesis ImperfectaOII


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uvenile idiopathicuvenile idiopathicsteoporosissteoporosisIJOJO


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Normal or increased hydroxyprolineexcretion


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/PP , , ,Bone and joint pains knees tibias

,metatarsi back pain , ,Gait abnormalities muscle weakness

decreased physical fitness ,Fractures thoracic and lumbar,vertebrae long bone metaphyses

,deformation of the skeleton shortstature


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iagnosisiagnosis >BMD 2 SD below normal for age and

( - < )sex Z score 2 # (Compression spine no schmorl

,nodules deformation of single,vertebara bone atrophy

In cre a se d A lka n lin e p h o sp h a ta se


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Diagnosisiagnosis Exclusion of other causes of 2ry OP

Rheumatic disordrs GIT ( )Chronic liver disease labs

( )Chronic renal disease labs Drug intake /Abd U S PTH level ,T3 T4

( , )OI increased Procollagen type I (1ry hypoparathyroidism low ca


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TTTTT

.5 t o 2 y s Ca rich diet , ,Ca vit D Calcitonin


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rognosisrognosis Most children with IJO experience a

.complete recovery of bone tissueAlthough growth may be somewhat

impaired during the acute phase of

,the disorder normal growth resumes - and catch up growth often occurs

. ,afterward Unfortunately in some

,cases IJO can result in permanentdisability such as curvature of the( )upper spine kyphoscoliosis or a

collapse of the rib cage


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ailure to achieve PBMailure to achieve PBM ,Over the past 3 decades there has

been an increase in the incidence offractures in children


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% - . .63 of 5 17 y o not active enough foroptimal growth

Adolescents less active than children

- ( % %)2 12 years old 33 vs 43

Decline in activity with age and( -gender girls at 14 15 yrs vs boys

- )16 17 yrs

: %Girls less active than boys 30 vs% - % %50 at 5 12 yrs vs 25 vs 40 at-13 17 yrs

-Girls less intense physicalactivities


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ffects of inactivityffects of inactivity Childhood obesity Type 2 diabetes

Hypertension Osteoporosis Depression / /Smoking alcohol drugs Adolescent pregnancy


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, ,T V com p u te r N in te n d o In a ctiv e p a re n ts In a d e q u a te a cce ss to q u a lity p h y sica l

e d u ca tio n cla sse s La ck o f re cre a tio n a l fa cilitie s


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MD measurementMD measurement DXA ( /BMD g cm2)= /BMC surface area

-

:score .compare the pt BMC to healthy young adults= ( )number of SDs away from the healthy populationmean BMD epidemiological studies have confirmed

an association between measurements ofBMD and fracture risk in the adult

population ( ) WHO classification defines osteoporosis

- .as a T score of 2 5 or Below and- .osteopenia as aT scorebetween1and2 5


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cquisition of peak bonecquisition of peak bonemassass The rate of bone mass acquisition

tends to mirror height velocity and.is greatest during puberty Bone

mass continues to accumulate until, ,the late teens early twenties at( )which time peak bone mass PBM is

achieved

Women tend to reach PBM sooner than

men and blacks sooner than whites[ ]. , %7 9 On average 90 of PBM isacquired by the age of 19 years


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MD in pediatricsMD in pediatrics WHO criteria for diagnosing

osteoporosis in adults should not beapplied to children

-The use of T scores is not applicablebecause children have not yetreached PBM

, Instead a child s BMD must be-converted to a Z score by comparison

.to pediatric normative data Theterm low bone density for

chronologic age should be used if- - .the Z score is below 2 0 SD


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iagnosis of OP iniagnosis of OP inpediatricsediatrics presence of both a clinically

significant fracture history one fracture of the long bones in the

,lower extremities vertebral

,compression fractures or two or more-long bone fractures of the upperextremities

a n d lo w b o n e m a ss


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one Health for Childrenone Health for Children -se age appropriate teachingtools ncourage healthy bone building

:abits Calcium itamin D

upplemented for exclusivelybreastfed erve fortified foods

ncourage regular exercise


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one Health for Adolescentsone Health for Adolescents t risk due to rapid growth ( )alcium 1300 mg hour exercise :void risky behaviors ating disorders -ver exercising

: , ,eer influence smoking alcohol nabolic steroids


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oal for Daily Calciumoal for Daily CalciumIntakentake ( )ge years ( )alcium mg to 3 400 to 8 800 -18

1300 -9 50 1000 +1

1200


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dequate Intake of Vitamindequate Intake of VitaminD( )or Healthy Individuals)or Healthy Individuals

( )ge years ( )itamin D IU per day irth to 50 200 1 to 70

400 +1 600 ( ome individuals require much)ore


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xercise has thexercise has the:otential to:otential to ncrease bone density in youthnd young adulthood

aintain and may modestlyncrease bone ensity in adulthood revent and minimize kyphosis ncrease muscle mass mprove balance and agility -educe the risk for fall relatedfractures


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hysical Activityhysical Activity eight bearing

ut stress through the bone mpact exercises

Resistance xercises that cause compressionhrough the bone as the musclecontracts

alance training


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hysical Activityhysical Activity eight bearing

,oderate intensity 30 minutes,o 1 hour ost days of the week

Resistance ,to 10 exercises 8 to 12,epetitions 2 times per week

alance training ,ai Chi specific exercises

1-12 Osteoporosis in Childern - Dr. Hesham a Ghany

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